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Should teenage girls with anorexia nervosa be offered oestrogen treatment to reduce later risk of osteoporosis?
  1. Pooneh Zadeh1,
  2. Lucinda Etheridge2
  1. 1 St George's University, London, UK
  2. 2 Paediatric Department, St George's Hospital, London, UK
  1. Correspondence to Dr Lucinda Etheridge, Paediatrics, St George's Hospital, London SW17 0QT, UK; lucinda.etheridge{at}

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A 14-year-old girl with anorexia nervosa (AN) comes to the paediatric clinic. She has been having treatment with the Community Eating Disorders Service for 1 year. She continues to be underweight with a percentage median body mass index of 82%. She reached menarche at the age of 11, although her last menstrual cycle was 24 months ago at the age of 12. She has had a dual-energy X-ray absorptiometry scan which reveals low bone mineral density (BMD), with a Z score of −2.8 in both hip and spine. Her parents are concerned about later risk to her bone health and ask if she should start oestrogen treatment to reduce her risk of developing osteoporosis.

Structured clinical question

In postpubertal adolescent girls with anorexia nervosa and secondary amenorrhoea who have low bone mineral density (population), does oestrogen therapy (intervention) reduce later risk of osteoporosis (outcome)?


We searched MEDLINE via PubMed and the Cochrane Library for primary and secondary sources up to November 2019 using the search terms ‘(anorexia OR anorexia nervosa OR eating disorder OR amenorrhoea) AND (oestrogen OR estrogen OR oral contraceptive) AND (bone mineral density OR osteoporosis) AND (adolescent girl OR teenage girl OR young people)’.

A total of 263 results were found. None were directly related to the outcome of reducing later risk of osteoporosis as there are currently no long-term data available addressing osteoporosis prevention in this risk group. Twenty-five papers were identified for further abstract review based on their focus on BMD. Nine papers (eight primary sources and one secondary source) were selected and graded (table 1) according to the Oxford Centre for Evidence Based Medicine Levels of Evidence.1

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Table 1

Summary of included studies


AN is an eating disorder characterised by a significantly low body weight accompanied by consistent behavioural patterns, such as restricted eating and excessive exercise, to prevent …

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  • Contributors LE conceived the idea for the topic. PZ carried out the literature search and critical analysis and wrote the initial manuscript. Both authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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